Jersey Finger

Definition

  • Avulsion of the flexor digitorum profundus (FDP) tendon from the base of the distal phalanx.
Jersey Finger

Mechanism

  • Sudden forcible extension of an actively flexed finger.
  • Classically occurs in sports such as soccer or rugby, where a player grabs another player’s jersey as they pull away.

Anatomy

  • Most commonly occurs in the ring finger (?why).
  • The tendon avulses from its attachment to the distal phalanx and may retract proximally towards the PIP joint or even further into the palm.

Clinical Assessment

LOOK

  • Swollen finger distally.
  • Bruising over distal phalanx and DIP joint.

FEEL

  • Maximally tender at base of distal phalanx and DIP joint on volar surface.
  • May be tender all along the volar surface of the finger.

MOVE

  • Unable to actively flex DIP joint.
  • Flexion at PIP and MCP joints preserved.

Imaging

  • Finger x-ray to assess for avulsion fracture.
  • USS/MRI to assess the degree of tendon retraction.

Radiological Assessment

  • The x-ray may be normal or may show evidence of an avulsion fracture.
  • Look for an avulsion fracture arising from the FDP insertion site on the volar aspect of the base of the distal phalanx.
  • A fleck of bone often retracts proximally with the tendon and may be visualised volar to the PIP joint.
Jersey Finger XR 1
Further Radiology Cases

Case 1

This 30-year old male presented with pain, swelling and bruising in his distal ring finger after a game of rugby. He gave a history of a sudden “pop” and immediate pain in the finger after grabbing another player’s jersey. On examination he was unable to actively flex his distal phalanx.

Jersey Finger XR 1
Image Interpretation and Clinical Outcome
  • His X-ray shows a large avulsion fracture at the FDP insertion site on the volar aspect of the base of the distal phalanx.
  • There also appears to be a smaller fleck of bone at the level of the PIP joint, suggesting that the FDP tendon has retracted proximally to this level.
  • USS confirmed tendon retraction and he was immobilised in a POSI splint and referred urgently to a hand surgeon, with open tendon repair performed a few days later.


Emergency Management

  • Analgesia
  • Splintage: Apply a POSI splint (position of safe immobilisation) and elevate the limb in a High Arm Sling.
VIDEO TUTORIAL | POSI splint; High Arm Sling
  • POSI splint (position of safe immobilisation) [Vimeo Video]
  • Triangular Bandage High and Broad Arm [Vimeo Video]

Lilian Wong and Matt Lutze demonstrate how to apply a POSI splint and High Arm Sling in these short videos from the Emergency Care Institute (with commentary by John Mackenzie).


Disposition

  • Refer urgently to a hand surgeon.
  • The patient will require an open tendon repair within 7-10 days.
  • These injuries carry a worse prognosis if not repaired within 7-10 days as the tendon contracts and becomes less viable.

Discharge Advice

  • Provide the patient with plaster care advice.
  • Ensure they are aware of the need for early surgical repair and hence the need to follow up promptly with the hand surgeon.

Pearls & Pitfalls

  • Examining specifically for loss of DIPJ flexion is critical to making this diagnosis.
  • Ensure you always isolate FDP and FDS when assessing the patient with a hand injury. Read how to do this here.
  • Partial FDP avulsion may present with pain on resisted DIPJ flexion but otherwise preserved FDP function. If uncertain whether a patient has an FDP injury, it is safer to immobilise them in POSI and refer to a hand surgeon.

Associated Injuries


References

Further Reading (LITFL Topics)

Authors

  • Lilian Wong (ED Physiotherapy Practitioner, Sydney)
  • Ed Burns (Emergency Physician, Sydney)
  • Matt Lutze (ED Nurse Practitioner, Sydney)

TRAUMA LIBRARY 700

TRAUMA LIBRARY

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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